NPI | 1013766336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC031) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY TC031) |
363AS0400X Physician Assistant, Surgical (Licence: KY TC031) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2024-05-17 |
Last Update Date | 2024-09-03 |